"You're forty" is not a fucking diagnosis!

[elfs]

So I went to the doctor today. She tapped around and she said, "I think you were right the first time. You don't have any evidence of a hernia; there's no bulging, your belly sounds right when I tap on it, there are no unusual sounds. The muscle spasm and the symptoms after it are completely consistent with a bruised and inflamed lower esophageal sphincter."

Then she told me to take twice the daily recommended dose of Prilosec and said, "If that doesn't clear it up--" And then she shrugged. "You're forty. This just happens to some people about this age." She proceeded to list all of the things I could no longer eat if the condition didn't clear up: coffee, chocolate, alcohol, spicy foods. Yeah, may as well take away all the other pleasures in life too, while they're at it.

She was competent and all, but I don't like this shrug-the-shoulders attitude toward impending decrepitude one bit.

Meanwhile, I still have an acid feeling in my throat, my voice is hoarse from the damage it's doing, and I can't lay down and sleep comfortably with this going on.

Comments

[rhonan.livejournal.com]

Welcome to adult-hood.

[elfs.livejournal.com]

But this is not adulthood. This is decrepitude. There's a difference. You'd think by now there'd be something more significant done about it than mucking with your biochemistry and disabling your stomach's acid production.

[rhonan.livejournal.com]

Ah, but decrepitude is adulthood. For those of us over 40, we are now in the slow decline to the grave. The adulthood part of that is to keep the slide as slow as possible, and to deal with that decrepitude with grace. You have stomach acid issues, I get to deal with joint pain and damaged feet. What we both have is the realization that our vitality is no longer something we can take for granted. The fact that your issue showed up between bouts of kink shows you are probably doing it right, the fight for vitality, that is.

[zonereyrie.livejournal.com]

Those symptoms sound just like me - and it my diagnosis ended up being a partial hiatal hernia and GERD. I'm a spicehead, so it was really annoying. I used to eat Tums like candy - at least twice a day, often a lot more than that. Anything acidic killed me - OJ, coffee, etc. Sometimes I'd have trouble swallowing and could cough food back up - unpleasant.

I've been on Protonix (or the generic thereof) for a couple of years now and it is night and day. No symptoms, no problems, no pain.

There is no physical sign of a hiatal from the outside, since it is an internal hernia. For me it took things like a barium swallow and an endoscopy to diagnose.

[jenk]

My initial meeting with a new ARNP began this year when she bustled in, took my hand, and said, "Hello, Jennifer! So, you are 41 years old! You are young and healthy so we will keep you that way! Here, sit on the table! So, you have problems with asthma?"

And off we went. Quite refreshing.

[mo-hair.livejournal.com]

perhaps a chiropractor? i think of mine as my own personal miracle worker.

[resonant.livejournal.com]

wait, what?

you don't look 40 in your picture. Late 20s, I guessed, and was wondering how you'd managed to write so much.

[elfs.livejournal.com]

I'm 41, yep. Omaha's lucky too; she's managed to maintain pretty much the same look for the past 15 years. A friend of ours wanted to know how much baby's blood we have to drink to achieve it.

[grian-ruadh.livejournal.com]

I used to have pretty nasty acid problems. Proton-pump inhibitors (chiefly Ranitadine) were my best friend. I also discovered that a half a tablespoon of baking soda stirred into a glass of water doesn't taste that bad at all and puts out the fire in the back of the throat. A wedge pillow to elevate my head at night also helped me sleep when the reflux was at its worst.

I feel for you, man. Acid sucks. Hope it gets better soon.

[acelightning.livejournal.com]

[doodlesthegreat.livejournal.com]

Get a second opinion. That doctor is a twit.

[kyriani.livejournal.com]

Definitely agree with those who say you should get a second opinion... I've definitely not had good experiences with most doctors, like being told I as a "sedentary female" when I was in martial arts twice a week, playing string bass, and in drama... Or being told I was too young to make any decisions about my reproductive organs when I had cramps bad enough to make me pass out and definitely ideas on whether I was having children or not. ;p There are some dreadful doctors out there, and some really mediocre ones. I'm actually happy with my current ARNP and my gyn who did my surgery, lots of info and very few judgement calls (they both harped on past smoking history).
I wish you the best in getting over what you have, it sounds nasty. =/

[elfs.livejournal.com]

To be fair, she was older than I was. And she said she has this problem.

[elfs.livejournal.com]

I've discovered that the real culprit seems to be pop. Nothing else makes the acid go quite like a big dose of phosphoric acid on top. Ah, well, I was hoping to cut pop out of my diet anyway.

a few points...

[edichka2.livejournal.com]

Zantac (ranitidine) is not a proton pump inhibitor (PPI); it is a histamine-2 receptor blocker (H2B). Proton pump inhibitors such as Prilosec (omeprazole) are much more potent than H2B's, although I have had one patient who swore that ranitidine was more effective for him. PPI's are still the mainstay and usually the best treatment for gastric acid disorders, particularly GERD.

Prilosec is the prototypical PPI and still the one I prescribe most often -- it works fine for most people, and it's fairly inexpensive and available OTC. Nexium (esomeprazole, an "upgraded" omeprazole) is what I usually see prescribed by gastroenterologists, but they're seeing a select and probably more severe population. My patients with more severe problems vary considerably and vociferously as to whether they prefer Nexium, Aciphex, Protonix, or Prevacid (the rest of the PPI family). Prilosec can be dosed up to 80mg daily, but most people do well with the standard dose of 20mg daily.

There are other remedies that are helpful for peptic ulcer disease and gastritis, but esophageal disorders tend to do best on PPIs.

Hiatal hernias are quite common, usually do not cause any more symptoms than garden-variety acid reflux (often entirely asymptomatic), and usually are treated the same way. It's pretty uncommon for a hiatal hernia to require surgical treatment.

I'm not entirely clear on what the, uh, circumstances of your injury were, but I wouldn't get too panicky just yet.

G'luck,
- E

Re: a few points...

[(Anonymous)]

My pharmacist told me recently that the latest recommendation for Omeprazole is to eat the pill ~30mins before a meal. Then, it turns off all the proton pumps (acid makers) as they get activated for the meal.

Not sure how much of a difference 'twill make, but worth suggesting.

CthaWorld

Re: a few points...

[elfs.livejournal.com]

The circumstances were straightforward. I was sitting on the ground and leaned forward to stretch out, and had a muscle spasm. I was between rounds of kink, as it were.

She's got me on 40mg of Prilosec right now. I'm mostly just annoyed at the added expense and overhead. Dammit, bodies shuoldn't require this much maintenence. They didn't when I was younger. What am I doing wrong?

[rarkrarkrark.livejournal.com]

Gah. I had reflux diaged as a teen (as in the random mouthfull-of-stomach-acid sort) and they claimed there was nothing to do for it other than antacids. I don't have to deal with it anymore, not because of drugs but because I found the food culprits. And it wasn't anything on their list. It was legumes. Everything except for peanuts. And since they were also giving me eczema (another "nothing you can do about it. Here, slather yourself in topical corticosteroids", but funny, I'm not 90% covered in it any more either, and I haven't had to refill the cyclocort in years) too it was a no-brainer for me. Milk for awhile but I'm back on it and okay again and I'm not sure if it's not actually milk+legumes anywhere in my diet rather than just milk.

The problem with this approach is that it doesn't work for everyone and it's hard to check for because the actual problematic foods are so variable. But imo it beats "nothing you can do about it." I've had doctors repeatedly assure me that any improvement *must* be psychosomatic, but damn, if I'm psychosomatically not covered in eczema and psychosomatically not ending up with mouthfuls of stomach acid, throat damage, heartburn, etc I'll take that too. :) (Given that when I've accidently gotten into legumes that I didn't know about -- specifically had foods that had small amounts of hydrolyzed soy protein in sauces [worcestershire and the like] I've had recurrences of symptoms -- I actually doubt that it's the psychosomatic/placebo effect)

[grum]

Adding my 2 cents to the pile that says try the Prilosec and if it doesn't work, try a different doc/arnp/whatever. At any rate, you're 40 is NOT a diagnosis, especially not when the change is not a gradual "well, it's been going down hill, and it's only now bad enough for me to try the doctor". You have an event you can trace to the start of symptoms. That seems to me like it warrants a little more investigation.

Add me to the "find a new doctor" camp

[danlyke.livejournal.com]

I'm only behind you by a little bit, but two years ago or so I took up road cycling. I was pretty proud that I've managed to stay in decent enough shape to stay towards the front of the pack and pull the occasional lead, until one day on a climb I was out fighting some twenty year old for the summit and we both got our asses handed to us by a guy who's 70 who broke from the pack a couple of hundred feet behind us and just completely smoked us.

Age is definitely not a diagnosis, find a doctor who's willing to take that seriously.